功名不遂，大狂七年 —Mania after Imperial Examination Failur

鲍, 三十二岁, 十月初二日大狂七年，先因功名不遂而病。

A 32-year-old man had been insane for seven years after he failed the examination. 

本京先医、市医、儒医，已历不少，既徽州医、杭州医、苏州医、湖北医，所阅之医，不下数百矣。大概补虚者多，攻实者少。间有已时，不旋踵而发。

He had been diagnosed and treated by hundreds of doctors from his hometown Huizhou, as well as Hangzhou, Suzhou and Hubei Hospitals. Occasionally he was well and normal, but after a while he became insane again. Most of his doctors had chosen treatment methods to tonify rather than reduce.

余初诊时，见其蓬首垢面，下体俱赤，衣不遮身，随作随毁，门窗分碎，随钉随拆，械系手足，外有铁索数根，锢锁于大石盘上，言语之乱，形体之羸，更不待言。细询其情，每日非见妇人不可。妇人不愿见，彼尽闹不可，叫号声嘶，衰鸣令人不可闻，只得令伊芳姬外家强侍之，然后少安，次日仍然，无一日之空。

When I (Wu Jutong, 1757–1841) first saw him, his face was dirty and his hair disheveled, he was in rags and his private parts which appeared totally red were exposed. The doors and windows were destroyed and smashed to pieces and he had removed all their nails. Wherever he went, there was bound to be chaos and mess. His family had to tie his hands and feet to a big millstone with iron chains, not to mention what kind of confusion he was in, and how thin and weak he was. Further inquiry showed that everyday he was eager to see women, and if he was not fulfilled he would fly into a rage,shouting and whining hoarsely in a way that was unbearable to hear. His family had to ask maids and concubines to serve him so that hecould calm down, but the same thing would happen again the next day, and the next.

诊其脉六脉，弦长而劲，余曰：“此实症，非虚症也。”于是用极苦以泻心胆二经之火，泻心者必泻小肠，病在脏，治其腑也，但无出路，亦必泻小肠也。

I felt his pulse and found that all sixpositions were taut, long and powerful which indicated he had an excess and not a vacuity syndrome. So I gave him the bitterest herbs in order to clear heatfrom the heart and small intestine channels. In some cases when the zang organs have problems, we treat their interior-exteriorly related fu organs. According to this theory, I cleared the man's heart heat by purging the stool and urine to clear heat via his small intestine.

龙胆草（三钱）胡黄连（三钱）天门冬（三钱）细生地（三钱）丹皮（三钱）大麦冬（三钱，连心）服二帖而大效，妄语少而举动安静，初三日，见其效也。以为久病体虚，恐过刚则折，用病减者，减其制例。于原方减苦药，加补阴之甘润。初五日，病家来告云：“昨服改方二帖，病势大重，较前之叫哮妄语，加数倍之多，无一刻静，此症想不能治，谅其必死，先生可不诊矣。”余曰：“不然，初用重剂而大效，继用轻剂加补阴而大重，吾知进退矣。” 复诊其脉，弦长而数，于是重用苦药。

Gentian root (9g), coptis rhizome(9g), asparagus tuber (9g), fresh rehmannia (9g),tree peony root coxtex (9g), ophiopogon tuber (9g). After only two days there was a big change – he began to cry and rave much less, and to behave much more quietly, and by the third day the effect ofthe formula was obvious. But I thought that, because of the long course of the disease, he was too weak to bear the harsh properties of the formula. It is said that too much hardness will result in a break, so I reduced the bitter herbs and added some with sweet and rich properties to nourish yin–fluids. On the fifth day the patient's family sent someone, saying that after taking two doses of the new formula yesterday, he suddenly became much worse. He cried and raved much more again and was unable to calm down for even one minute. His family thought that maybe this kind of disease couldn't be cured and he was certain to die, so they asked me not to treat him any more. But I didn't think so. The first formulawas harsh but had been very effective, and when the more gentle yin-nourishing formula was given his condition deteriorated again. It seemed I had initially understood the nature of his symptoms after all. I checked his pulse again,which was still taut, long and rapid, so I increased the content of the bitter herbs.

龙胆草（六钱）洋芦荟（六钱）天冬（五钱）麦冬（五钱，连心）胡黄连（五钱）秋石（二钱）乌梅肉（五钱）一气六帖，一日较一日大效，至十一日大为明白。于是将其得病之由，因伊念头之差，因未识文章至高之境，即欲至高，尚有命在，非人力所能强为，何怒之有。人生以体亲心为孝，痛乎责之，俯首无辞。以后渐去苦药，加补阴，半月而后，去刑具，着衣冠，同跪拜，神识与好人无异。服专翕大生膏一料而大壮，下科竟中矣。